避光输液套的制作与使用

长期以来,临床护士常将计算机打印的静脉输液卡悬挂在静脉输液架上,以便在输液过程中进行查对并签写每组药液的执行时间和执行者姓名[1]。我院从2005年开始,改进静脉输液巡视卡的项目和内容,并将输液挂卡和输液巡视卡合二为一,严格落实输液巡视制度,有效监控输液全过程,提高了护理质量,杜绝医疗事故的发生。现介绍如下。1输液巡视卡的设计临床使用计算机打印的静脉输液卡。内容包括:开始时间、停止时间、巡视时间、巡视内容及巡视护士签名。其设计见下表。视卡床号:姓名:性别:日期:开始时间停止时间巡视时间巡视内容药物药瓶查对药液滴速点…     

一次性输液器胶管的用途

静脉输液配挂输液巡视卡后,提高了静脉输液患者的护理质量,有效杜绝了护理差错、事故的发生。工作中发现输液巡视卡以绷带代替的挂绳给护士操作消毒带来不便,我们采用一次性输液器胶管代替绷带,因一次性输液器胶管配挂巡视卡后     

巡视卡在静脉输液中的应用

静脉输液是临床治疗常用的方法之一 ,是临床护理的重要内容。我院自从应用静脉输液巡视卡以来 ,有效地提高了输液病人的护理质量 ,受到病人及家属的好评。现将具体做法报告如下。　　每个输液病人输液架上挂一静脉输液巡视卡 ,护士根据护理级别按要求填写床号、姓名、用药时间、剂量、滴速、余量、全身反应、局部反应并签名。使用巡视卡要求对病危、一级护理的输液病人每 10ｍｉｎ～ 2 0ｍｉｎ巡视一次并登记 ,二级护理的输液病人每 30ｍｉｎ～ 45ｍｉｎ巡视一次并登记 ,其中更换液体、拔针者 ,随时登记并签名。输液完毕后取回巡视卡 ,按日…     

巧用书写垫板制作静脉输液巡视挂卡

静脉输液是临床治疗中的重要方法,静脉输液巡视是护理工作的重要内容.而使用输液巡视卡是临床护理静脉输液工作中的规范化管理的重要内容[1].在静脉输液过程中,通常将计算机打印(或手抄)的静脉输液巡视卡装在静脉输液卡袋内,悬挂于静脉输液架上,以便在输液过程中签写每组药液的执行时间及执行者姓名,并可以及时了解病人输液进行情况.     

巧用书写垫板制作静脉输液巡视挂卡

静脉输液是临床治疗中的重要方法,静脉输液巡视是护理工作的重要内容.而使用输液巡视卡是临床护理静脉输液工作中的规范化管理的重要内容[1].在静脉输液过程中,通常将计算机打印(或手抄)的静脉输液巡视卡装在静脉输液卡袋内,悬挂于静脉输液架上,以便在输液过程中签写每组药液的执行时间及执行者姓名,并可以及时了解病人输液进行情况.     

巧用书写垫板制作静脉输液巡视挂卡

静脉输液是临床治疗中的重要方法,静脉输液巡视是护理工作的重要内容.而使用输液巡视卡是临床护理静脉输液工作中的规范化管理的重要内容[1].在静脉输液过程中,通常将计算机打印(或手抄)的静脉输液巡视卡装在静脉输液卡袋内,悬挂于静脉输液架上,以便在输液过程中签写每组药液的执行时间及执行者姓名,并可以及时了解病人输液进行情况.     

输液巡视观察卡在临床护理中的应用体会

目的完善临床客观护理资料,确保静脉输液科学安全有效进行。方法在临床工作中使用静脉输液巡视观察卡,客观详实记录输液过程。结果减少和避免了输液不良反应及差错的发生,提高静脉输液的安全性和患者满意度,进一步规范了护理行为,调动护士的主动服务意识,护理质量环节管理得到加强,同时提高了护理质量。结论静脉输液期间的质量管理是一项长期的、持续的工作,需要不断地在工作中发现问题,不断健全护理管理机制,才能为患者提供更加安全、有序、合理地优质护理服务。     

静脉输液巡视本在临床中的应用

目的探讨设立静脉输液巡视本（以下简称输液巡视本）的管理方法和效果。方法在我院住院部内科、儿科、外科、妇产科使用输液巡视本。护理部定期进行检查，及时进行整改。结果自2005年1月开始使用输液巡视本，患者因输液问题发生的床头传呼器使用次数从平均每天11次下降到3次，住院患者对护士服务态度满意度从90％上升为96％。结论输液巡视本配合静脉输液卡使用后，使静脉输液巡视实行了规范化管理，输液巡视动态管理的可操作性增强，加强了护患沟通和护士之间的协作，同时输液巡视本还可成为评价护士工作质量的客观依据之一。     

输液巡视卡在静脉输液观察中的应用评价

静脉输液是临床治疗最常采用的方法之一，使用静脉输液巡视卡能使护士工作由被动服务变为主动巡视，加强了工作责任心，加强了护患之间的联系，护士之间团结一心，提高了护理质量，杜绝了医疗纠纷，推动了科室护理工作安全有序的进行。     

静脉输液巡视卡的应用评价

静脉输液是临床治疗中的重要方法，是临床护理中的常见工作。通过静脉输液可及时输入药物，配合医生治疗，使病人早日康复。因此加强巡视，保证液体顺利输入防止药液外漏等输液意外，尤为重要。我院针对这一问题，实行了规范化管理，使用静脉输液巡视卡，将护理工作由过去的被动观察变为主动观察，加强了护士的事业心及责任感，提高了整体护理的护理质量水平。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.